Special needs children with chronic medical or developmental conditions already have it tough, but a study from MUSC indicates that being bullied or shunned poses a greater risk of anxiety or depression than the challenges presented by a medical condition.
The study, presented by lead investigator Margaret Ellis McKenna, M.D., senior fellow in MUSC's Developmental-Behavioral Pediatrics Department, investigated the impact of bullying, ostracism and diagnosis of chronic medical condition on the emotional well-being of children with special health care needs, ages 8 to 17.
When looking at both parent and child reports, McKenna found ostracism (being left out or ignored) by peers was the strongest indicator of symptoms for depression or anxiety and that ostracism and bullying often go hand-in-hand. This finding may come as a surprise to some, particularly given the immense physical health challenges these children must face.
"These findings show that despite all the many challenges these children face in relation to their chronic diagnoses, being bullied or excluded by their peers was the factor most likely to predict whether or not they reported symptoms of depression," McKenna said.
Participants were recruited from MUSC during routine visits to their physician. Participants and their parent or guardian completed three questionnaires that screened for emotional well-being (psychosocial adjustment). In all, there were 109 participants with a variety of chronic medical or developmental diagnoses.
Main categories of diagnosis included:
--ADHD (39 percent)
--cystic fibrosis (22 percent)
--Type I and II diabetes (19 percent)
--learning disability (11 percent)
--sickle cell disease (11 percent)
--obesity (11 percent)
--autism spectrum disorder (9 percent)
There were several children who had a combination of these diagnoses. One questionnaire screened for symptoms of depression, while the other two questionnaires broadly screened for "internalizing conditions," which include anxiety and depression.
The child's age, gender and scored self-reports of being bullied or ostracized were analyzed. Previous research has shown that ostracism and being bullied often occur together, which McKenna also found in this group of children. Based on the children's answers, these two factors were the strongest indicators of depression or other internalizing symptoms.
Given these findings, McKenna recommends that health and education professionals increase the levels of vigilance needed to identify bullying and ostracism in this already vulnerable group of children. For example, she suggests that schools adopt policies to prevent and address ostracism, with the goal of implementing programs that promote a culture of inclusion and a sense of belonging for all students.